Individual
SANDRA I AGAZIE, MSN, APRN, PMHNP-BC, CMSRN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
115 BRADFORD SQ STE B, FAYETTEVILLE, GA 30215-1962
(404) 736-4343
(844) 870-7142
Mailing address
7586 OLDHAM LN, RIVERDALE, GA 30274-3595
(404) 736-4343
(844) 270-7142
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN170538
GA
163WM0705X
Medical-Surgical Registered Nurse
RN170538
GA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
RN170538
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0031333861D
—
GA
05
—
003133861A
—
GA
05
—
003133861B
—
GA
05
—
003149239A
—
GA
05
—
003315273A
—
GA
Enumeration date
05/13/2025
Last updated
10/10/2025
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